July News 2013 (Final Session Report)

The legislative session isn’t really over until the Governor either signs or vetoes the bills sent to him.  In Iowa, the Governor has 30 days from the time session ends to make these decisions.  The Governor finished his work with a couple of days to spare, approving a budget that increases spending by 3% but making several vetoes that may significantly impact services to Iowans with disabilities.  

While the Governor held a bill signing ceremony to celebrate the historic compromise that will give more than 150,000 Iowans access to free or low cost health insurance, he quietly used his veto authority on the same bill to cut out funds intended to protect services to Iowans with disabilities as the redesign enters its second transitional year. 

The Governor vetoed:

• $8.7 million that would have taken thousands of Iowans off Medicaid waiver waiting lists.  Right now, some counties provide services to people while they wait for a Medicaid slot to become available, so these additional dollars could have helped free up some county/regional funds.
  
  
• $13 million that would have gone into a Risk Pool to help the 45 counties that will be forced to collect fewer dollars locally for MH/DS services, and who have no other source of state dollars to balance that out.  Some of these counties may have to cut services or stop paying providers in order to live on this reduced budget.
  
  
• Language that would have made sure regions kept their current funding levels for the State Payment Program even if the federal funds are reduced, helping them smoothly make the switch from legal settlement to residency.  Border counties and “magnet counties” where people go to get services may feel these cuts more than others – and they may be forced to make cuts in order to live within their local funding levels.
  
  
• $250,000 that would have moved the mental health advocates (who help people going through the involuntary commitment process) to the state and created uniform standards to ensure consistency and accountability.  Counties will continue to pay for these advocates, who vary widely in experience, education, and workload.  

To compound the issue, the Governor signed language that requires counties to pay back any savings they get in their MH/DS systems because people are now eligible for the newly created Iowa Health and Wellness Plan.   

So while the Governor signed $29.8 million in funding for non-Medicaid regionally delivered services to people with disabilities, he cut over $22 million in funds that would have stabilized services to Iowans with disabilities, and some of that $29.8 million will need to be repaid to the state next year.  

In addition, three counties (Polk, Clinton, Scott) that have about $2 million in unspent risk pool funds must return those funds to the state, and counties that have outstanding Medicaid bills are required to use their remaining local dollars to repay those funds by June 30, 2014.   Any one of these vetoes could have resulted in some setbacks in the redesign of the mental health and disability services system, but the combination of these cuts could threaten the stability of the entire MH/DS system.

You can read the Govenror's veto message on the waiver waiting list here, and on the risk pool here.

Concerned? Wondering what you can do?  Unfortunately, these changes are now law and your legislators can’t fix things until the session starts up again in January.  But they can start working on a solution now.  Talk to your legislators.  They are back home now, in their districts, back at their “regular” jobs.  Call them and ask them what they can do to fix this situation (and ask what you can do).  Click here to find out who represents you at the Iowa Capitol, and how you can reach them this summer.

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About the “Medicaid Offset”

Counties would calculate how much money they save in local mental health and disability services dollars because a person that previously received locally funded services is now getting those services paid for by the Iowa Health and Wellness Program.   At the end of the year, the county would have to repay 80% of those savings (called the “offset”).  They are to repay this using their equalization funds. If they didn’t receive equalization funds, the county must lower its property tax levy by the amount of this “offset.”  If the county’s savings is more than its equalization dollars, the county must repay the funds and lower its levy. 

There were several legislators that were not comfortable with this requirement – so they asked for a Medicaid Offset Study Committee to review the impact of the offset and determine what this will do to the newly forming regions’ ability to make progress on meeting the new core services requirements.  This committee will be assigned on July 18, when the Legislative Studies Committee meets and determines which interim committees will meet and who will serve on them.  Watch the website (www.infonetiowa.org) for more on this.

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As mentioned before, the Governor signed into law the Iowa Health and Wellness Program that was adopted by the Legislature in the final days of the legislative session.  This carefully crafted compromise gives low-income Iowans access to health insurance by:

1. Expanding Medicaid for Iowans earning up to 100% of the federal poverty level. This new Medicaid plan (called the “Wellness Plan”) and its benefit package would be similar to the State Employees Plan.  It is expected to include parity in mental health coverage, but will probably not include transportation (although the Federal government could still require it).
   
   
2. Giving Iowans earning between 101-138% of the federal poverty level private insurance plan coverage paid for by Medicaid.  People would be able to choose from the two insurers that have said they will offer plans on the Health Insurance Exchange (CoOpportunity and Coventry). Eligible Iowans would have to take part in certain preventive health activities, like getting an annual physical, in order for their coverage to remain free. This part of the Iowa Health and Wellness Program is called the “Marketplace Choice Plan.” 

Both parts of the Iowa Health and Wellness Plan will require federal approval.  To get federal approval, the state must file two state plan amendments for the Medicaid expansion portion of the program (to create the new eligibility group and to create a separate benefits package) and two demonstration waivers (one that allows waivers from certain Medicaid requirements, and another allowing federal dollars to be used to purchase private insurance plans).  

The Iowa Medicaid Enterprise is busily writing these plans and waivers, and will have them available for public comment later this month.  They plan to host public hearings around the state on July 21-23 (but details on these meetings are not yet available).  They will take public comment at the meetings, but comments can also be submitted by email or mail. Iowa Medicaid plans to submit the waivers and state plan amendments on August 19. As part of the application process, the Iowa Medicaid Enterprise must show how they addressed issues brought up by the public.  After the plans are submitted, the Federal government will also have a public comment period.

The state has to be ready to go when enrollment begins on October 1.  Iowans have only until March 2014 to sign up for this new coverage, so you can see that things will move very quickly.  While we can’t tell you much more now, we will continue to provide updates on our website (www.infonetiowa.org) and on Facebook, or watch for more details here.

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 What to know what other appropriations and bills were signed into law?  Here are a few options:

• Click here for a custom list of bills signed into law or vetoed by the Governor. 
• Click here for a PDF of this custom list.
• Click here for a list of all bills signed/vetoed by Governor.
• Click here for the non-partisan legislative staff review of the legislation passed this year.
• Click here for the non-partisan legislative staff review of budgets passed this year (click on the ones marked "final").
• Click here for a list of bills that didn't make the cut this year (they are "alive" again next session; just select "inactive").

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